产后出血后发生肾功能不全的危险因素

高洪; 钱传云

产后出血后发生肾功能不全的危险因素

高洪¹,
钱传云²

1. 曲靖市第一人民医院重症医学科
2. 昆明医科大学第一附属医院急诊ICU

基金项目:

基金：云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目 (2014FZ006);

计量
- 文章访问数: 2029
- HTML全文浏览量: 736
- PDF下载量: 42
- 被引次数: 4
出版历程
- 收稿日期: 2018-01-13

An Analysis of Risk Factors of Renal Inadequacy after Postpartum Hemorrhage

Gao Hong ¹,
Qian Chuan Yun ²

Funds:

基金：云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目 (2014FZ006);

摘要

摘要: 目的探讨产后出血后发生肾功能不全的危险因素.方法根据产后出血的诊断标准, 回顾分析2010年1月至2014年12月发生产后出血并入住重症监护室的产妇病史资料200份.记录产妇的一般情况, 妊高症 (PIH) 及妊娠期糖尿病 (GDM) 病病史, ASA分级, 麻醉方式, 分娩方式, 产后出血量等指标.采用Logistic回归分析产后出血后发生肾功能不全的危险因素.结果 200例发生产后出血并入住重症监护室的产妇, 发生产后肾功能不全的21例 (10.5%) .年龄2044岁, 平均 (29.24±4.58) 岁;根据ASA评估标准评判患者术前情况, 其中ASA分级I级179例 (89.5%) , II级20例 (10.0%) , III级1例 (0.5%) , IV级0例.经阴道分娩147例 (73.5%) , 剖宫产53例 (26.5%) .椎管内麻醉 (含分娩镇痛) 196例 (98.0%) , 全身麻醉4例 (2.0%) .妊娠期间患有高血压疾病者12例 (6.0%) , 未患者188例 (94.0%) .有妊娠期糖尿病病史者9例 (4.5%) , 无妊娠期糖尿病病史者191例 (95.5%) .结论年龄大于35岁, 剖宫产分娩, 妊娠期高血压病史及妊娠期糖尿病病史是产后出血后发生肾功能不全的危险因素.
- 产后出血 /
- 肾功能不全 /
- 危险因素
Abstract: Objective To investigate the risk factors of renal inadequacy after postpartum hemorrhage.Me thods According to the diagnostic criteria of postpartum hemorrhage, 200 cases of postpartum hemorrhage who were admitted to the Intensive Care Unit from January 2010 to December 2014 were collected. The general situation, history of pregnancy induced hypertension and gestational diabetes mellitus, ASA classification, anesthesia method, delivery mode, postpartum hemorrhage and other indicators. The risk factors were analyzed by logistic regression.Re s ults Among 200 cases of postpartum hemorrhage who were admitted in the intensive care unit, 21 cases with renal insufficiency were seenafter delivery (10.5%) aged between 20 and 44 years old with the average age of (29.24 ±4.58) years old. Using the ASA evaluation criteria to evaluate the preoperative situation, we observed179 cases in ASA grade level I (89.5%) , 20 casesin level II (10%) , one casein level III (0.5%) and no case in grade IV. Among all the women, we found 147 cases of vaginal delivery (73.5%) , 53 cases of cesarean section (26.5%) , 196 cases of spinal anesthesia (including labor analgesia) (98%) and 4 casesof general anesthesia (2%) . There were 12 patients with hypertension during pregnancy (6%) , and 188 patients without hypertension (94%) . There were 9 cases of gestational diabetes mellitus (4.5%) , and 191 patients without gestational diabetes mellitus (95.5%) .Conclus ions The risk factors of renal insufficiency after postpartum hemorrhage were: age older than 35 years, cesarean delivery, pregnancy history of hypertension or gestational diabetes mellitus.
- Postpartum hemorrhage /
- Renal inadequacy /
- Risk factor

HTML全文

参考文献(17)

[1]谢敏, 张超, 王建六, 等.妊娠合并慢性肾脏疾病患者的围产结局及其危险因素分析[J].中华妇产科杂志, 2012, 47 (3) :161-165.
[2]赵郁虹, 吉凯强, 臧彬, 等.ICU妊娠重症患者预后中慢性肾脏病的发病情况及相关影响因素分析[J].中国全科医学, 2013, 16 (38) :3798-3801.
[3]	[3]BONNAR J.Massiveobstetric haemorrhage[J].Baillie re’s Best Pract Res Clin Obstet Gynaecol, 2000, 4 (4) :1-18.
[4]	[4]PRITCHARD J A, BALDWIN R M, DICKEY J C, et al.Blood volumechanges in pregnancy and the puerperium.II.Red blood cell lossand changes in apparent blood volume during and following vaginaldelivery, cesarean section, and cesarean section plus total hysterectomy[J].Am J Obstet Gynecol, 1962, 84 (8) :1271-1282.
[5]	[5]American College of Obstetricians and Gynecologists.Educational Bulletin No.243.Postpartum haemorrhage[J].Int J Gynecol Obstet, 1998, 61:79-86.
[6]	[6]READ J A, COTTON D B, MILLER F C.Placenta accreta:changing clinicalaspects and outcome[J].Obstet Gynecol, 1980, 56:31-34.
[7]	[7]CHANG J, ELAM–EVANSLD, BERG C J, et al.Pregnancy-related mortalitysurveillance United States.1991-1997[J].MMWR, 2003, 52 (2) :1-8.
[8]	[8]DOMISSEEJ, TILTMAN A J.Placental bed biopsies in placental abruption[J].Br J Obstet Gynaecol, 1992, 99 (19) :651-654.
[9]	[9]MEHRABADIA, LIU S L, BARTHOLOMEW S.Hypertensive disorders of pregnancy and the recent increase in obstetric acute renal failure in Canada:population based retrospective cohort study[J].BMJ, 2014, 349:4731-4734.
[10]	[10]GODDIJN-WESSEL T A, WOUTERS MG, VAN DE MOLEN E F, et al.Steegers theunssen RP.hyperhomocystenemia a risk factorfor placental abruption or infarction[J].Eur J Obstet Gynecol Reprod Biol, 1996, 66 (6) :23-29.
[11]	[11]SIBAI B M, VILLAR M A, MABIE B C.Acute renal failure in hypertensivedisorders of pregnancy.Pregnancy outcome and remote prognosis inthirty-one consecutive cases[J].Am J Obstet Gynecol, 1990, 162 (3) :777-783.
[12]	[12]LEEMAN L, DRESANG L T, FONTAINE P.Hypertensive disorders of pregnancy[J].Am Fam Physician, 2016, 93 (2) :121-127.
[13]朱君玲, 王艳秋.妊娠合并急性肾损伤的发生率和危险因素分析[J].中国全科医学, 2011, 14 (2) :119-121.
[14]薛晴, 杨慧霞.妊娠合并急性肾功能衰竭[J].中国医刊, 2003, 38 (8) :22-24.
[15]	[15]HILDEBRAND A M, LIU K, SHARIFF S Z, et al.Characteristics and outcomes of AKI treated with dialysis during pregnancy and the postpartum period[J].J Am SocNephrol, 2015, 26:3085-3091.
[16]	[16]PAHWA N, BHARANI R, KUMAR R.Post-partum acute kidney injury[J].Saudi J Kidney Dis Transpl, 2014, 25 (6) :1244-1247.
[17]	[17]LIU Y M, BAO H D, JIANG Z Z, et al.Pregnancy-related acute kidney injury and a review of the literature in China[J].Intern Med, 2015, 4 (14) :1695-1703.

相关文章(20)

[1]	周文林, 牛奔, 苏恒. 特发性低促性腺激素性性腺功能减退症的临床危险因素分析, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20230727
[2]	熊世锋, 邹浩. 胆囊癌淋巴结转移的危险因素分析, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20220318
[3]	张桂梅, 陈蜀, 宋云华, 吴阳, 周虹媛. AECOPD患者再入院危险因素分析及预测模型的构建, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20220830
[4]	路伟民, 杨小涛, 朱瑛, 黄艺, 陈后余, 金海凤, 王艳春. 儿童恙虫病175例的临床特征及重症恙虫病危险因素, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20220814
[5]	吴华杰, 张楠, 李磊, 乔涵, 李国萍. 甲状腺癌发病的危险因素及预防策略研究进展, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20220526
[6]	周敏, 马智慧, 李加艳, 范建华, 林灵, 余亭颖, 张慧芳, 刘立. 肝硬化并胸水再发危险因素的预测, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20220524
[7]	贾万优, 刘红莉, 蒋薇薇, 李红敏, 张硕, 费继敏. 甲状腺术后甲状旁腺功能减退的风险因素, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20220904
[8]	王静, 朱真真, 白钰璇, 贾志彬, 任燕龙. 脑卒中后吞咽功能障碍继发吸入性肺炎的危险因素, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20220214
[9]	陈科容, 周文刚, 施红伶, 刘天云, 林惠仙, 张梅. 吞咽功能障碍患者合并胃食管反流危险因素, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20221230
[10]	王爱华, 杨奕梅, 孙宇, 包蕾. 术前轻度血小板减少症对剖宫产术后产后出血的影响, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20220921
[11]	王静, 唐莲芳, 顾美群, 许小艳, 余建华, 何山, 李紫薇, 毕凯, 刘丽巧, 赵琼, 米弘瑛. 新生儿坏死性小肠结肠炎的危险因素及早期临床特点, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20211118
[12]	孟泽祖, 鲜航, 侯晓进, 魏石磊, 马继, 赵睿, 丛锐. 断指再植术后血管危象相关危险因素, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20210122
[13]	杨丽娜, 耿力. 低危妊娠阴道分娩发生产后出血的危险因素分析, 昆明医科大学学报.
[14]	李军. 昆明市出租车司机疲劳与相关健康和安全危险因素, 昆明医科大学学报.
[15]	戴梅. 昆明市儿童哮喘的危险因素分析, 昆明医科大学学报.
[16]	李芫苑. 云南宾川一起肝片吸虫病暴发的危险因素调查, 昆明医科大学学报.
[17]	刘漪. 呼吸重症监护病房多重耐药鲍曼不动杆菌感染危险因素回顾性分析, 昆明医科大学学报.
[18]	罗静. 剖宫产致产后出血经介入治疗失败后行子宫全切术9例报道, 昆明医科大学学报.
[19]	. 孤立肾合并鹿角形结石临床治疗52例报道, 昆明医科大学学报.
[20]	杨秋萍. 心血管危险因素聚集与心率变异性的关系研究, 昆明医科大学学报.

施引文献

期刊类型引用(3)

1.	杨秀芳，曹伍兰，陈简，朱侨伟，郑婉文，曾柳钰. 联合PBL和iSIM情景模拟教学在产儿团体合作培训中的应用. 中国医学教育技术. 2024(03): 384-388 . 百度学术
2.	吕宇航，任倩. 产妇产后出血并发肾功能损伤的影响因素分析. 中国妇幼保健. 2022(17): 3230-3233 . 百度学术
3.	苏畅，周梦林，陈丹青. 浙江省154家医院及其助产人员难产助产技术开展和掌握情况研究. 中华医学教育杂志. 2022(07): 665-669 . 百度学术